Workplace Violence: An Uncomfortable, Yet Important Topic

In acute and critical care settings nurses work with patients and their families in times of high stress and vulnerability. Although it can be greatly rewarding to help patients and families during these difficult times, there are also downsides for nurses, including workplace violence.¹  Health care workers, including nurses, were 5 times more likely to experience an injury from workplace violence compared with other workers.² 

Workplace violence is defined as an act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior by another person in the workplace.¹  Unfortunately, workplace violence incidents continue to increase in the health care setting. The Joint Commission, a US health care accreditation body, reissued a Sentinel Alert in 2021 on workplace violence, highlighting increased risks, especially in units such as emergency departments and inpatient psychiatric units.³  Factors contributing to workplace violence included “stressful conditions, understaffing, and lack of organizational policies to recognize and deescalate hostile behaviors.”³  The Joint Commission offers several resources on their website such as a checklist for prevention strategies, an infographic, and information to help support policy development.³ 

When I first started working in critical care in the 1980s, we did not talk much about violence against nurses. These situations did occur, but they seemed to be less common than in today’s world. At that time, there may have been a perception that some degree of physical or verbal assault was just an unfortunate part of the job, something to be quietly tolerated. We were wrong. Although this mindset may have been accepted when it came to misbehavior from patients, we understood clear boundaries when workplace violence originated from a patient’s family member or even another team member.

Two incidences of workplace violence stood out in my early career. One situation originated from a family member who physically reached out and pinned a male intensive care unit (ICU) physician against a wall after hearing bad news about their loved one. Fortunately, the situation was quickly deescalated, but it was a wake-up call to realize that if physical violence could be directed toward to one of our most compassionate physicians, it could happen to anyone.

Another situation involved the emotional abuse of an ICU nurse by a physician. A surgeon yelled obscenities at a nurse in the middle of a busy ICU station during a day shift. This event was observed by many of the nurse’s colleagues, who watched in shock as the event unfolded. I was pleasantly surprised that our health care administrators took prompt action and suspended the surgeon’s hospital privileges for a period of time. This action sent a strong message that emotional abuse would not be tolerated.

Workplace violence in the health care environment, particularly in acute and critical care settings, affects not only the safety and well-being of nurses but it also has the potential to negatively influence the quality of patient care.⁴  As frontline providers of care in high-stress environments, critical care nurses often face verbal abuse, physical assaults, and emotional distress. More recently, nurses have started to have important yet difficult conversations around the topic of pressing charges against patients who abuse them.^4,5 

I invited Mel Cortez, a critical care nurse and expert in workplace violence, to write a guest editorial for this issue of Critical Care Nurse.⁶  Although this topic may seem heavy for the holiday season, I hope that nurses will feel empowered to assess risks for workplace violence, implement protection strategies, develop organizational policies, and maximize their personal safety. Fostering a respectful workplace culture with zero tolerance strategies is a step closer to the healthy work environment that all nurses deserve.

All the best for the holiday season and the New Year! Be well!